Co-utilization of glucose and xylose for the production of poly-ß-hydroxybutyrate (PHB) by Sphingomonas sanxanigenens NX02.

BACKGROUND: Poly-ß-hydroxybutyrate (PHB), produced by a variety of microbial organisms, is a good substitute for petrochemically derived plastics due to its excellent properties such as biocompatibility and biodegradability. The high cost of PHB production is a huge barrier for application and popularization of such bioplastics. Thus, the reduction of the cost is of great interest. Using low-cost substrates for PHB production is an efficient and feasible means to reduce manufacturing costs, and the construction of microbial cell factories is also a potential way to reduce the cost. RESULTS: In this study, an engineered Sphingomonas sanxanigenens strain to produce PHB by blocking the biosynthetic pathway of exopolysaccharide was constructed, and the resulting strain was named NXdE. NXdE could produce 9.24 ± 0.11 g/L PHB with a content of 84.0% cell dry weight (CDW) using glucose as a sole carbon source, which was significantly increased by 76.3% compared with the original strain NX02. Subsequently, the PHB yield of NXdE under the co-substrate with different proportions of glucose and xylose was also investigated, and results showed that the addition of xylose would reduce the PHB production. Hence, the Dahms pathway, which directly converted D-xylose into pyruvate in four sequential enzymatic steps, was enhanced by overexpressing the genes xylB, xylC, and kdpgA encoding xylose dehydrogenase, gluconolactonase, and aldolase in different combinations. The final strain NX02 (ΔssB, pBTxylBxylCkdpgA) (named NXdE II) could successfully co-utilize glucose and xylose from corn straw total hydrolysate (CSTH) to produce 21.49 ± 0.67 g/L PHB with a content of 91.2% CDW, representing a 4.10-fold increase compared to the original strain NX02. CONCLUSION: The engineered strain NXdE II could co-utilize glucose and xylose from corn straw hydrolysate, and had a significant increase not only in cell growth but also in PHB yield and content. This work provided a new host strain and strategy for utilization of lignocellulosic biomass such as corn straw to produce intracellular products like PHB.

Controlled Synthesis, Chiral Assembly, and Circularly Polarized Luminescence of Poly(Phenyl Isocyanide)-Block-Polyfluorene Copolymers.

In this work, π-conjugated block copolymers consisting of poly(phenyl isocyanide) (PPI) and polyfluorene (PF) segments are facilely prepared by one-pot sequential polymerization of phenyl isocyanide (monomer 1) and 7-bromo-9,9-dioctylfluorene-2-boronic acid pinacol ester (monomer 2). The Pd(II)-terminated PPI is first prepared via polymerizing monomer 1 catalyzed with phenyl alkyne-Pd(II) complex and then utilized to initiate the controlled Suzuki cross-coupling polymerization of monomer 2, yielding various PPI-b-PF copolymers possessing controlled molar mass and narrow dispersity. Owing to the helical conformation of PPI segment and π-conjugated structure of PF segment, PPI-b-PF copolymers present distinctive optical property and fascinating chiral self-assembly behavior. During the self-assembly process, chirality transfer from helical PPI block to the supramolecular aggregates of helical nanofibers occurs to afford optically active helical nanofibers with high optical activity. Furthermore, the self-assembled helical nanofibers exhibit excellent circularly polarized luminescence performance.

Investigation of the transport and metabolic patterns of oil-displacing bacterium FY-07-G in the microcosm model using X-CT technology.

AIMS: Microbial enhanced oil recovery (MEOR) is dedicated to enhancing oil recovery by harnessing microbial metabolic activities and their byproducts within reservoir rocks and fluids. Therefore, the investigation of microbial mobility and their extensive distribution within crude oil is of paramount importance in MEOR. While microscale models have been valuable for studying bacterial strain behavior in reservoirs, they are typically limited to 2D representations of porous media, making them inadequate for simulating actual reservoir conditions. Consequently, there is a critical need for 3D models and dependable visualization methods to observe bacterial transport and metabolism within these complex reservoir environments. METHODS AND RESULTS: Bacterial cellulose (bc) is a water-insoluble polysaccharide produced by bacteria that exhibits biocompatibility and biodegradability. It holds significant potential for applications in the field of MEOR as an effective means for selective plugging and spill prevention during oil displacement processes. Conditionally cellulose-producing strain, FY-07-G, with green fluorescent labeling, was engineered for enhanced oil recovery. 3D micro-visualization model was constructed to directly observe the metabolic activities of the target bacterial strain within porous media and to assess the plugging interactions between cellulose and the medium. Additionally, X-ray computed tomography (X-CT) technology was employed for a comprehensive analysis of the transport patterns of the target strain in oil reservoirs with varying permeabilities. The results indicated that FY-07-G, as a microorganism employing biopolymer-based plugging principles to enhance oil recovery, selectively targets and seals regions characterized by lower permeability and smaller pore spaces. CONCLUSIONS: This work provided valuable insights into the transport and metabolic behavior of MEOR strains and tackled the limitation of 2D models in faithfully replicating oil reservoir conditions, offering essential theoretical guidance and insights for the further application of oil-displacing bacterial strains in MEOR processes.

Plastic mulching, and occurrence, incorporation, degradation, and impacts of polyethylene microplastics in agroecosystems.

Polyethylene microplastics have been detected in farmland soil, irrigation water, and soil organisms in agroecosystems, while plastic mulching is suggested as a crucial source of microplastic pollution in the agroecosystem. Plastic mulch can be broken down from plastic mulch debris to microplastics through environmental aging and degradation process in farmlands, and the colonization of polyethylene-degrading microorganisms on polyethylene microplastics can eventually enzymatically depolymerize the polyethylene molecular chains with CO2 release through the tricarboxylic acid cycle. The selective colonization of microplastics by soil microorganisms can cause changes in soil microbial community composition, and it can consequently elicit changes in enzyme activities and nutrient element content in the soil. The biological uptake of polyethylene microplastics and the associated disturbance of energy investment are the main mechanisms impacting soil-dwelling animal development and behavior. As polyethylene microplastics are highly hydrophobic, their presence among soil particles can contribute to soil water repellency and influence soil water availability. Polyethylene microplastics have been shown to cause impacts on crop plant growth, as manifested by the effects of polyethylene microplastics on soil properties and soil biota in the agroecosystems. This review reveals the degradation process, biological impacts, and associated mechanisms of polyethylene microplastics in agroecosystems and could be a critical reference for their risk assessment and management.

A population-based study to assess two convolutional neural networks for dental age estimation.

BACKGROUND: Dental age (DA) estimation using two convolutional neural networks (CNNs), VGG16 and ResNet101, remains unexplored. In this study, we aimed to investigate the possibility of using artificial intelligence-based methods in an eastern Chinese population. METHODS: A total of 9586 orthopantomograms (OPGs) (4054 boys and 5532 girls) of the Chinese Han population aged from 6 to 20 years were collected. DAs were automatically calculated using the two CNN model strategies. Accuracy, recall, precision, and F1 score of the models were used to evaluate VGG16 and ResNet101 for age estimation. An age threshold was also employed to evaluate the two CNN models. RESULTS: The VGG16 network outperformed the ResNet101 network in terms of prediction performance. However, the model effect of VGG16 was less favorable than that in other age ranges in the 15-17 age group. The VGG16 network model prediction results for the younger age groups were acceptable. In the 6-to 8-year-old group, the accuracy of the VGG16 model can reach up to 93.63%, which was higher than the 88.73% accuracy of the ResNet101 network. The age threshold also implies that VGG16 has a smaller age-difference error. CONCLUSIONS: This study demonstrated that VGG16 performed better when dealing with DA estimation via OPGs than the ResNet101 network on a wholescale. CNNs such as VGG16 hold great promise for future use in clinical practice and forensic sciences.

Construction of liquid metal-based soft microfluidic sensors via soft lithography.

BACKGROUND: Liquid metal (LM) can be integrated into microfluidic channel, bringing new functionalities of microfluidics and opening a new window for soft microfluidic electronics, due to the superior advantages of the conductivity and deformability of LMs. However, patterning the LMs into microfluidic channels requires either selective surface wetting or complex fabrication process. RESULTS: In this work, we develop a method to pattern the LMs onto the soft elastomer via soft lithographic process for fabrication of soft microfluidic sensors without the surface modification, bulky facilities, and complicated processes. The combination of the interfacial hydrogen bond and surface tension enables the LM patterns transfer to the soft elastomer. The transferred LM patterns with an ellipse-like cross-section further improve the stability under the mechanical deformation. Three proof-of-concept experiments were conducted to demonstrate the utilization of this method for development of thermochromic sensors, self-powered capacity sensors and flexible biosensor for glucose detection. CONCLUSIONS: In summary, the proposed method offers a new patterning method to obtain soft microfluidic sensors and brings new possibilities for microfluidics-related wearable devices.

Microbial enhanced oil recovery through deep profile control using a conditional bacterial cellulose-producing strain derived from Enterobacter sp. FY-07.

BACKGROUND: Heterogeneity of oil-bearing formations is one of major contributors to low oil recovery efficiency globally. Long-term water flooding will aggravate this heterogeneity by resulting in many large channels during the exploitation process. Thus, injected water quickly flows through these large channels rather than oil-bearing areas, which ultimately leads to low oil recovery. This problem can be solved by profile control using polymer plugging. However, non-deep profile control caused by premature plugging is the main challenge. Here, a conditional bacterial cellulose-producing strain, namely Enterobacter sp. FY-0701, was constructed for deep profile control to solve the problem of premature plugging. Its deep profile control and oil displacement capabilities were subsequently identified and assessed. RESULTS: The conditional bacterial cellulose-producing strain Enterobacter sp. FY-0701 was constructed by knocking out a copy of fructose-1, 6-bisphosphatase (FBP) encoding gene in Enterobacter sp. FY-07. Scanning electron microscope observation showed this strain produced bacterial cellulose using glucose rather than glycerol as the sole carbon source. Bacterial concentration and cellulose production at different locations in core experiments indicated that the plugging position of FY-0701 was deeper than that of FY-07. Moreover, enhanced oil recovery by FY-0701 was 12.09%, being 3.86% higher than that by FY-07 in the subsequent water flooding process. CONCLUSIONS: To our knowledge, this is the first report of conditional biopolymer-producing strains used in microbial enhance oil recovery (MEOR). Our results demonstrated that the conditional bacterial cellulose-producing strain can in situ produce biopolymer far from injection wells and plugs large channels, which increased the sweep volume of injection water and enhance oil recovery. The construction of this strain provides an alternative strategy for using biopolymers in MEOR.

Carbon Fiber-Based Flow-Through Electrode System (FES) for Water Disinfection via Direct Oxidation Mechanism with a Sequential Reduction-Oxidation Process.

Flow-through configuration for electrochemical disinfection is considered as a promising approach to minimize the formation of toxic byproducts and energy consumption via the enhanced convective mass transport as compared with conventional flow-by one. Under this hydrodynamic condition, it is essential to ascertain the effect of sequential electro-redox processes with the cathode/anode then anode/cathode arrangements on disinfection performance. Here, carbon fiber felt (CFF) was utilized to construct two flow-through electrode systems (FESs) with sequential reduction-oxidation (cathode-anode) or oxidation-reduction (anode-cathode) processes to systematically compare their disinfection performance toward a model Escherichia coli ( E. coli) pathogen. In-situ sampling and live/dead backlight staining experiments revealed that E. coli inactivation mainly occurred on anode via an adsorption-inactivation-desorption process. In reduction-oxidation system, after the cathode-pretreatment, bulk solution pH increased significantly, leading to the negative charge of E. coli cells. Hence, E. coli cells were adsorbed and inactivated easily on the subsequent anode, finally resulting in its much better disinfection performance and energy efficiency than the oxidation-reduction system. Application of 3.0 V resulted in ∼6.5 log E. coli removal at 1500 L m-2 h-1 (50 mL min-1), suggesting that portable devices can be designed from CFF-based FES with potential application for point-of-use water disinfection.

[Analysis of SATB2 gene mutation in a child with Glass syndrome].

OBJECTIVE: To analyze the clinical characteristics and genetic basis of a child affected with Glass syndrome. METHODS: Clinical manifestations and auxiliary examination results of the child were analyzed. Potential mutation was detected with next generation sequencing and validated by Sanger sequencing. RESULTS: The child has featured growth and mental retardation, delayed speech, cleft palate, crowding of teeth, and downslanting palpebral fissures. DNA sequencing revealed a de novo heterozygous missense mutation c.1166G>A (p.R389H) in exon 8 of the SATB2 gene in the child. CONCLUSION: The heterozygous mutation c.1166G>A (p.R389H) of the SATB2 gene probably account for the Glass syndrome in the patient.

Multifunctional bacterial cellulose-bentonite@polyethylenimine composite membranes for enhanced water treatment: Sustainable dyes and metal ions adsorption and antibacterial properties.

Developing multifunctional materials for water treatment remains a significant challenge. Bacterial cellulose (BC) holds immense potential as an adsorbent with high pollutant-binding capacity, hydrophilicity, and biosafety. In this study, N-acetylglucosamine was used as a carbon source to ferment BC, incorporating amide bonds in situ. Bentonite, renowned for its adsorption properties, was added to the culture medium, resulting in BC-bentonite composite membranes via a one-step fermentation process. Polyethyleneimine (PEI) was crosslinked with amide bonds on the membrane via glutaraldehyde through Schiff base reactions to enhance the performance of the composite membrane. The obtained membrane exhibited increased hydrophilicity, enhanced active adsorption sites, and enlarged specific surface area. It not only physically adsorbed contaminants through its unique structure but also effectively captured dye molecules (Congo red, Methylene blue, Malachite green) via electrostatic interactions. Additionally, it formed stable complexes with metal ions (Cd²âº, Pb²âº, Cu²âº) through coordination and effectively adsorbed their mixtures. Moreover, the composite membrane demonstrated the broad-spectrum antibacterial activity, effectively inhibiting the growth of tested bacteria. This study introduces an innovative method for fabricating composite membranes as adsorbents for complex water pollutants, showing significant potential for long-term wastewater treatment of organic dyes, heavy metal ions, and pathogens.

Enhancing Wound Healing and Bactericidal Efficacy: A Hydrogel Membrane of Bacterial Cellulose and Sanxan Gel for Accelerating the Healing of Infected Wounds.

Bacterial cellulose is an extracellular polysaccharide produced by microorganisms, offering advantages such as high water-holding capacity, flexibility, and biocompatibility. However, its lack of bactericidal activity hampers its wide application. Usnic acid, a secondary metabolite derived from lichens of the Usnea genus, is recognized for its antibacterial and anti-biofilm efficiency, coupled with anti-inflammatory properties. Its water insolubility presents challenges for wide utilization and stable release. Sanxan gel, a novel polysaccharide, exhibits exceptional freeze-thaw stability, suspension properties, and high elasticity, rendering it effective as a suspending agent to improve the bioavailability of water-insoluble drugs. In this study, a hydrogel membrane is designed by combining bacterial cellulose and usnic acid suspended in sanxan gel through a simple in situ microorganism fermentation. The obtained membranes demonstrate excellent ability for sustained drug release, strong eradication capability against tested bacteria in both in vitro and in vivo experiments, effective inhibition of biofilm formation, and excellent hemocompatibility and cytocompatibility. Additionally, the composite membranes promote wound healing with reduced inflammation and bacterial infection in a full-thickness wound infection model in mice. This study provides innovative insights and strategies for the development of functional dressings for infected wounds in future clinical applications.

Coagulation and ozonation treatment of biologically treated wastewater from recycled paper pulping industry: effect on the change of organic compounds.

Recycled paper pulping wastewater (RPPW) will cause serious environmental problems due to the high loads of dissolved organic matter (DOM) and toxic components. In the present work, the degradation of DOM in the biologically treated RPPWs (cardboard wastewater (CW) and corrugated container wastewater (CCW)) by a combined coagulation and ozonation process was investigated. The optimal chemical oxygen demand (COD) removal of CW reached 73.64% at aluminum sulfate (Al2(SO4)3) dosage of 800 mg/l, aeration aperture of 10 µm, pH of 9, hydrogen peroxide (H2O2) dosage of 100 mg/l, and reaction time of 70 min. The optimal COD removal of CCW reached 55.76% at a poly-aluminum chloride (PAC) dosage of 700 mg/l, H2O2 dosage of 140 mg/l, and reaction time of 50 min. This study provided some insights into the change of DOM during the combined treatment through the use of UV-Vis spectroscopy and excitation-emission matrix spectroscopy (EEM). PAC and Al2(SO4)3 removed high molecular weight organic such as lignin and lignin-derived compounds to improve the biodegradability of the wastewater. Ozone oxidized high molecular weight organic with complex functional groups to low molecular weight organic with simple functional groups and even mineralization, and this phenomenon resulted in the COD of ozonation effluent significantly reduced. Thus, the results presented in this study support the application of the combined coagulation and ozonation process in treating RPPW.

Piezoelectric PDMS/AlN Film for Osteogenesis in Vitro.

Bone defect and nonunion are complex diseases which are difficult to treat due to insufficient bone regeneration. Electrical stimulation has attracted attention as a promising strategy to induce and enhance bone regeneration. Self-powered and biocompatible materials have been widely explored and used in biomedical devices, owing to their ability to produce electrical stimulation without an external power source. We aimed to prepare a piezoelectric polydimethylsiloxane (PDMS)/aluminum nitride (AlN) film with excellent biocompatibility and osteoconductive ability for the growth of murine calvarial preosteoblast MC3T3-E1 cells. By applying vibration to stimulate body movement, the PDMS/AlN film demonstrated a current density of 2-6 µA cm-2, and the generated continuous alternating current (AC) effectively promoted MC3T3-E1 cell growth, viability, and osteoblastic related gene expression (genes runt-related transcription factor 2 [RUNX2], osteocalcin [OCN], alkaline phosphatase [ALP]) and exhibited higher mineralization. Compared to blank plates and nonvibrated PDMS/AlN films, the vibrated PDMS/AlN film showed rapid and superior osteogenic differentiation. The design of the biocompatible and flexible piezoelectric PDMS/AlN film overcame the poor processability, brittleness, and instability of electrical stimulation of traditional electroactive materials, demonstrating great potential in the application of electrical stimulation for bone tissue engineering.

Fabrication of bacterial cellulose composites with antimicrobial properties by in situ modification utilizing the specific function-suspension containing water-insoluble magnolol.

In situ modification is commonly employed for Bacterial cellulose (BC) functionalization. However, water-insoluble modifiers are usually deposited at the bottom of the medium, therefore cannot be used for in situ modification of BC. Herein, a novel strategy for in situ modification of insoluble modifiers after suspension by a suspending agent was proposed. The BC-producing strain Kosakonia oryzendophytica FY-07, not Gluconacetobacter xylinus, was selected to prepare BC products with antibacterial activity because of its tolerance to natural antibacterial products. The experimental results showed that xanthan gum as a suspending agent can uniformly and stably disperse water-insoluble plant extracts magnolol in the culture medium to prepare the in situ modified BC products. Characterization of the properties showed that the in situ modified BC products have reduced crystallinity, significantly increased swelling ratio and strong inhibition on Gram-positive bacteria and fungi and weak inhibition on Gram-negative bacteria. Furthermore, the in situ modified BC products had no toxicity to cells. This study provided a feasible strategy for in situ modification of BC using water-insoluble modifiers to extend BC functionality and has significant implications for the biopolymer industry.

Cytotoxic tetraprenylated alkaloids from the South China Sea gorgonian Euplexaura robusta.

Nine achiral tetraprenylated alkaloids, including three new compounds, named malonganenones I-K (1-3, resp.), together with six known analogs, 4-9, were isolated from the gorgonian Euplexaura robusta collected from Weizhou Island of Guangxi Province, China. The structures of compounds 1-3 were elucidated by extensive spectral analyses, especially of their 1D- and 2D-NMR data. Compounds 1, 4, 6, and 7 showed moderate cytotoxicities against K562 and HeLa tumor cell lines with IC(50) values ranging from 0.35 to 10.82 µM. Compound 6 also showed moderate inhibitory activity against c-Met kinase at a concentration of 10 µM.

From Drug Molecules to Thermoset Shape Memory Polymers: A Machine Learning Approach.

Ultraviolet (UV)-curable thermoset shape memory polymers (TSMPs) with high recovery stress but mild glass transition temperature (Tg) are highly desired for 3D/4D printing lightweight load-bearing structures and devices. However, a bottleneck is that high recovery stress usually means high Tg. For a few TSMPs with high recovery stress, their Tg values are close to the decomposition temperature, and thus, the shape memory effect cannot be triggered safely and effectively. While machine learning (ML) has served as a useful tool to discover new materials and drugs, the grand challenge of using ML to discover new TSMPs persists in the very limited data available. Here, we report an enhanced ML approach by combining the transfer learning-variational autoencoder with a weighted-vector combination method. By learning a large data set with drug molecules in a pretraining process, we were able to effectively map the TSMPs to a hidden space that is much closer to a Gaussian distribution. Through this approach, we created a large compositional space and were able to discover five new types of UV-curable TSMPs with desired properties, one of which was validated by the experiments. Our contribution includes (1) representing the features of TSMPs by drug molecules to overcome the barrier of a limited training data set and (2) developing a ML framework that is able to overcome the barrier of mapping the molar ratio information. It is shown that this approach can effectively learn TSMP features by utilizing the relatedness between the data-scarce (and biased) TSMP target and data-abundant drug source, and the result is much more accurate and more robust than the benchmark set by the support vector machine method using direct label encoding and Morgan encoding. Therefore, it is believed that this framework is a state-of-the-art study in the TSMP field. This study opens new opportunities for discovering not only new TSMPs but also other thermoset polymers.

Highly efficient production of bacterial cellulose from corn stover total hydrolysate by Enterobacter sp. FY-07.

Bacterial cellulose (BC) has a huge global market due to its excellent properties and wide range of applications. However, due to high production costs, low productivity, and unsatisfactory scale-up production, industrialisation has been slow. Herein, stabilization of strain, optimisation of culture conditions, and a cheap carbon source were combined to achieve highly efficient, low-cost, large-scale BC production in 20 L containers. Optimisation of culture conditions increased both BC productivity and sugar conversion ratio significantly, from 2.08 g/L/day and 9.78% to 17.13 g/L/day and 70.31%, respectively. Furthermore, BC productivity and sugar conversion ratio reached 13.96 g/L/day and 85.50% using corn stover total hydrolysate as carbon source. The low-cost, facile, and highly efficient process can generate large quantities of BC, and could promote industrialisation of BC production.

Identification of SOFT syndrome caused by a pathogenic homozygous splicing variant of POC1A: a case report.

BACKGROUND: Pathogenic variants in POC1A led to SOFT syndrome and variant POC1A-related (vPOC1A) syndrome. SOFT syndrome is a rare primordial dwarfism condition characterized by short stature, onychodysplasia, facial dysmorphism and hypotrichosis.The main clinical differences between SOFT and vPOC1A syndrome include dyslipidemia with insulin resistance and acanthosis nigricans. To our knowledge, this is the first report of a SOFT syndrome patient diagnosed with a homozygous splicing variant, which could help to extend our understanding of the genotypic and phenotypic information of the disease. CASE PRESENTATION: We reported a seven-year-old boy with SOFT syndrome. The patient presented symmetrical short stature and facial features, including prominent forehead, inverted triangular face, epicanthal fold, small teeth and enlarged ears. Laboratory tests displayed mild insulin resistance. Whole-exome sequencing (WES) led to the identification of a homozygous splicing variant (c.981+1G>A) in POC1A gene of the patient, which was inherited from his heterozygous parents confirmed by Sanger sequencing. Further transcriptional experiments of the splicing variant revealed aberrant percentage of exon 9 skipping transcripts. CONCLUSIONS: This is the firstly reported case of a SOFT syndrome patient with a novel homozygous splicing variant and detailed delineation of the aberrant transcript in proband and carrier of the variant in Chinese. Our study enriched mutational spectrum of POC1A which could help in further genetic diagnosis and counselling of SOFT syndrome patients.

Production of nisin-containing bacterial cellulose nanomaterials with antimicrobial properties through co-culturing Enterobacter sp. FY-07 and Lactococcus lactis N8.

Bacterial cellulose (BC) is used in various fields for its unique physical properties, but does not have the antimicrobial properties needed for the food and biomedical industries. Co-culture fermentation is a method commonly used in biotechnology to address high costs. A nisin-containing BC film (BC-N) was obtained by co-cultivating the BC-producing strain Enterobacter sp. FY-07 with the nisin-producing strain Lactococcus lactis N8. The physical properties of BC-N were similar those of BC, but the BC-N film had a specific strong inhibitory effect on Gram-positive bacteria. The antibacterial mechanism of BC-N was pore formation, but the obtained BC-N film had no significant impact on mammalian cell viability. This study provides a low-cost, facile and efficient technique to confer BC with antimicrobial properties. This strategy can be applied to introduce other functions into BC, and develop applications for BC polymers.

A decision-tree model for predicting extubation outcome in elderly patients after a successful spontaneous breathing trial.

BACKGROUND: The commonly used single tests, based on a 1-time measurement of a physiologic variable, are often poorly predictive of tracheal extubation outcome because they examine only a single aspect of physiological function that affects the extubation outcome. We hypothesized that the construction of a decision-tree model, which includes multiple variables and considers the changes of these variables, may more accurately predict successful extubation. METHODS: This was a prospective observational study. From 2007 to 2008, 113 elderly patients in the medical intensive care unit on ventilation for >48 hours were enrolled. All patients underwent a 60-minute spontaneous breathing trial (SBT) [positive end-expiratory pressure of 5 cm H(2)O; automatic tube compensation, 100%]. Patients tolerating the trial were extubated immediately. The mouth occlusion pressure (P(0.1)), rapid shallow breathing index (RSBI,) and their combination (P(0.1) × RSBI) were recorded at the first, 30th, and 60th minute of the SBT. The changes in RSBI, which were determined at the 30th and 60th minute of the SBT (ΔRSBI30, ΔRSBI60), were assessed as the ratio (of RSBI30 or RSBI60) to RSBI at the first minute of the SBT. RESULTS: Twenty-two patients (19.5%) failed the SBT and were not included in the analysis, and 91 tolerated the trial and were extubated. At 48 hours, 73 (80.2%) remained extubated (successful extubation), and 18 (19.8%) required reintubation (extubation failure). Although theΔRSBI(30) was significantly higher in the extubation failure patients (118% ± 34%) than that in the successful extubation patients (93% ± 35%, P = 0.01), the receiver operating characteristic (ROC) analysis demonstrated that this index, with the threshold of <98%, presented poor performance in predicting successful extubation with area under the ROC curve (AUC) of only 0.76. The classification and regression-tree analysis selected 3 variables (P(0.1) × RSBI(30), RSBI(1), ΔRSBI(30)) and began with P(0.1) × RSBI(30). For patients with P(0.1) × RSBI-(30) >474 cmH(2)O*breaths/min/L, ΔRSBI(30) >98% defined a group including all failure patients but no success patients, whereas ΔRSBI(30) ≤98% included all success patients with no failure patients. For patients with P(0.1) × RSBI(30) ≤474 cm H(2)O*breaths/min/L, the combination of both a P(0.1) × RSBI(30) >328 cm H(2)O*breaths/min/L and RSBI(1) >112 breaths/min/L also defined a group including all success patients but no failure patients. Indeed, the diagnostic accuracy (DA) of the tree model, which was 89.1% with only the P(0.1) × RSBI(30) included, increased to 94.5% when both the P(0.1) × RSBI(30) and ▵RSBI(30) were included. The final tree model with the inclusion of all 3 discriminators could capture the successful extubation with diagnostic accuracy of 96.7%, AUC of 0.94 (95% confidence interval [CI], 0.87 to 0.98). CONCLUSION: If the current tree model is confirmed by a prospective study with a larger sample size, it would be useful in guiding physicians making extubation decisions in elderly medical intensive care unit patients.